Sexual dysfunction Flashcards
What is sensate focus?
Weiner and Avery-Clark, 2014
- Masters and Johnson (1970) first introduced sensate focus, which was the foundation of their sex therapy
- Sensate focus was used as a tool for identifying psychological and relationship factors that may be contributing to sexual difficulties and also for the teaching of new skills in order to overcome these problem factors
- It is used to improve sexual intimacy (make it more meaningful)
- Masters and Johnson (1970) asserted that sex is a natural function
- – They promoted the treatment for disturbances in natural functions, such as erection, lubrication, orgasm, etc.
- – Initial goal of treatment = to reduce performance anxiety/pressure
- – Redirecting attention onto sensory experience and engaging in voluntary behaviours
- – But sex could be a socially constructed phenomenon (Tiefer 1991)
- Sensate focus phase 1 = touching for one’s interest
- – Weiner, 2011
- – Not necessarily to arouse oneself or one’s partner, but for your own self and own interest = non-demand touching for self
- – Similar to mindfulness? The ability to focus solely on one thing at a time and fully appreciate the experience
- Sensate focus phase 2 = greater responsivity to partner feedback and emotional experience
- – Actively encourages partner communication about emotional experiences
- Sensate focus = a psychological attitude
- – Not specific behaviours or instructions
- Sensate focus has not been very well explained which has led to a lot of confusion about its purpose and implementation
- – Hence it is unlikely to have had as great an impact as it should have
- – But perhaps this is because the concept is too confusing; it may not be understood well enough to be explained properly yet; content and ideas may be too complex
What evidence is there to support the use of Masters and Johnson’s sex therapy?
Gupta, Banerjee and Nandi (1989)
- Study that investigated the effectiveness of a modified Masters Johnson technique for the treatment of male sexual dysfunction
- Men with erectile dysfunction and premature ejaculation (primary and secondary)
- 21 participants
— Small sample size
- All married
- 16 (76.2%) recovered
- All Indian hence ethnocentric bias
— Urban, middle-class families
— How generalisable is this population?
- 13/21 had developed depression following the onset of the sexual dysfunction – on antidepressants
— Mindfulness is thought to increase rumination when already in a depressive state – could this negatively impact on the individual’s result and/or mental state?
- However used the common misconception of sensate focus
— An objective is to give and receive pleasure
- No follow-up = how long did the improved effects last for?
- Not very applicable since uses a modified version of the technique = hence only provides support for the use of this modification, not the original technique
Pereira et al, 2013
- Sex therapy for female sexual dysfunction
- 27 studies included in review
- Sex therapy has best outcomes for orgasmic disorder and for sexual pain (dyspareunia and vaginismus)
— These are also the most extensively researched
— More research needed for other female sexual dysfunctions
— Hence sex therapy is not necessarily effective for all female sexual dysfunctions, and perhaps it should not always be the first line treatment
- Sex therapy is the most common form of therapy used for sexual dysfunction still
- Results do not consistently support sex therapy as the best alternative in the treatment of sexual dysfunctions
What evidence is there to support the use of psychotherapy for the treatment of male sexual dysfunction?
Melnik, Soares and Nasello (2007)
- 11 RCTs involving 398 men included
- Provides evidence that group psychotherapy may improve erectile function
- – Significantly improved ED compared to sildenafil citrate alone
- Focused sex-group therapy showed greater efficacy than control group (no treatment)
- In meta-analysis:
- – Men randomised to receive group therapy plus sildenafil showed significant improvement of successful intercourse and were less likely to drop out compared to those only receiving sildenafil.
- No differences were found regarding the effectiveness of psychosocial interventions compared to local injection, vacuum devices and other psychosocial techniques
What is the prevalence of male sexual dysfunctions?
Donahue and Swingen, 1999
- Prevalence of various male sexual dysfunctions is difficult to determine
— Due to lack of methodologically sound epidemiological research
— Insufficient information as to reliability and validity of the relevant diagnoses contained in the DSM
(— Significant questions about the quality of the DSM diagnosis for sexual dysfunctions (O’Donahue and Geer, 1993))
- Problems in gaining information about actual prevalence:
— Unrepresentative samples
— Assessment devices of unknown psychometric properties
— Researchers often develop their own measures
- Failure of articles to not include design features (such as a treatment manual and/or fidelity checks)
— Inability to replicate the study
- Small sample sizes in many studies
- All studies included in the review had many serious methodological flaws or contained insufficient information to allow replication of the study or to determine the viability of the causal inference and the generalisability of the results
- Review revealed no well-established treatments for male sexual dysfunctions
What evidence is there to support the use of psychotherapy for the treatment of female sexual dysfunction?
Trudel, Marchand, Ravart, Aubin, Turgeon, Fortier (2001)
- Found that CBT (compared with the control group) resulted in a significant improvement in the quality of sexual and marital life, sexual satisfaction, perception of sexual arousal, sexual self-esteem and less depression and anxiety for women with hypoactive sexual desire
- 77 couples included
- Exclusion of anyone with a major psychological disorder, such as depression
— Depression has a high co-morbidity with sexual dysfunction – will this affect the generalisability of the results?
- Waiting list control
- Follow up at 3 months and also at 1 year
Fruhaf, Schmidt, Gerger and Bauth (2012)
- Psychological interventions were shown to especially improve symptom severity for women with hypoactive sexual desire disorder and orgasmic disorder.
- Overall: psychological interventions are effective treatment options for sexual dysfunction
— But evidence varies considerably across single disorders
— Further research is required!
— Especially to look at their long term and comparative effects
- Psychological interventions vs wait-list
— Superior in improving symptom severity if conducted in a couple setting or a self-help setting
— Limited evidence found for it being superior if conducted in an individual setting
— Superior for sexual satisfaction if conducted in a group setting but not if conducted in a couple or self-help setting
- 20 randomised controlled studies included
— Psychological intervention vs waiting list control
- Criticism: variety of psychological interventions included – likely to be quite different and vary in method, hence probably should not have been lumped together
— Some may be effective, whereas others may not be
Heiman (2000)
- There is limited controlled research, with only orgasmic disorders meeting the more stringent “well established” criteria
— Promising but uncontrolled results for vaginismus and dyspareunia
— Minimal effectiveness data for hypoactive sexual desire disorder
— No available efficacy data on female sexual arousal disorder and sexual aversion
- Many of the studies looked at in this article were from before the mid-1980s
Lankveld et al., 2006
- 117 women with lifelong vaginismus were randomly assigned to receive cognitive behavioural group therapy, cognitive behavioural bibliotherapy (minimal contact) or to act as a waiting list control
- Intent to treat analysis
- Successful intercourse at post-treatment was reported by 14% of the treated participants compared with none of the participants in the control condition
- At the 12-month follow-up 21% of the group therapy participants and 15% of the bibliotherapy participants reported successful intercourse
- Cognitive behavioural treatment of lifelong vaginismus was thus found to be efficacious but there was only a small effect size
McMullen and Rosen, 1979
- 60 non-orgasmic women
- Equal number of married and single women
- Random assignment to: videotape modelling, written instructions or waiting list control
— Both treatment procedures involved a 6 week self-administered masturbation training program
- Of the subjects receiving treatment, 60% became orgasmic by the end of the treatment period
— 4 additional married subjects became orgasmic by the time of the 1-year follow-up
- For those subjects who failed to transfer orgasmic capacity to coital intercourse, the role of partner dysfunction is discussed
- Although no significant differences were found between the videotaped modeling condition and the written instructions group, the overall effectiveness of the treatment compares favorably with other treatment programs
How effective is sensate focus?
- The typical population for Masters and Johnson’s treatment = Caucasian, able-bodied, heterosexual married couples
— Ethnocentric and heterocentric bias
— How applicable is the sensate focus technique outside of this population?
Linschoten, Weiner and Avery-Clark, 2016 = critical literature review of sensate focus - Reviewed 84 literature sources = good sample size
- Found that sensate focus has been effectively used for the treatment of females with biomedical and/or psychological sexual concerns
- Vaginismus = Jindal and Jindal, 2010
- Useful technique to increase sexual desire, arousal and orgasmic responsivity
- Males: some effective interventions that include sensate focus exercises for males with inhibited sexual desire
- But mainly focused on erectile dysfunction
- Hence huge gaps in research!
- Non-heterosexual couples: support for effectiveness of sensate focus as an intervention for gay and lesbian couples
